NPIMap

Organization Active NPI

Tri-State Community Healthcare Center

  • Federally Qualified Health Center (FQHC)
  • Needles, CA
National Provider Identifier
1922356369
Registry record updated Jul 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TRI-STATE COMMUNITY HEALTHCARE CENTER
Practice address
820 W Broadway St
Needles, CA 92363-2729
Phone
(760) 326-0222
Fax
(760) 326-0221
NPI assigned
Aug 15, 2012
Last updated
Jul 10, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Aram Manoukian
Title
Ceo
Phone
(818) 652-6612

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Primary Care Clinic/Center 261QP2300X CA

Addresses

Primary practice location

820 W Broadway St
Needles, CA 92363-2729

Mailing address

820 W Broadway St
Needles, CA 92363-2729
Phone (760) 326-0222

Other practice location 1

1655 N Mount Vernon Ave Unit C
San Bernardino, CA 92411-1427
Phone (909) 577-1101

Other practice location 2

31739 Riverside Dr Ste A1
Lake Elsinore, CA 92530-7818
Phone (951) 245-0505

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20131114000307 CA Part B Supplier - Clinic/Group Practice 5597991968 Receives reassigned benefits from 79 practitioners
1 other NPI on this enrollment
Practice locations: Los Angeles, CA; San Fernando, CA; Pomona, CA; Needles, CA; Hemet, CA; Adelanto, CA
O20150909002402 CA Part A Provider - Federally Qualified Health Center (FQHC) 5597991968 Practice locations: Needles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922356369. Details of each certification follow.

Federally qualified health center certification: CCN 751185

Legal name
TRI-STATE COMMUNITY HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 20, 2015
Last certification
Aug 20, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 2011 in CA
Enrollment address
820 W Broadway St
Needles, CA 92363-2729

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2291990Tri State Community Healthcare Center820 W Broadway Street, Needles, CA 92363Certificate of waiverOct 17, 2027

National Provider Directory

National Provider Directory
Tax ID family
Tri-State Comm Hlthcare Ctr12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11499 Bartlett Ave
Adelanto, CA 92301
Phone (760) 444-4258

11273 Laurel Canyon Blvd
Ste 2
San Fernando, CA 91340
Phone (818) 853-2220

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
George Deleon Individual Corporate DirectorBoard Member Sep 14, 2017
Jeffrey Williams Individual Corporate OfficerBoard Chair (President) Jun 25, 2014
John Pazirandeh Individual Corporate OfficerCfo Sep 26, 2016
Kellie a McKenzie Individual Corporate DirectorBoard Member Sep 11, 2017
Mark Hannawi Individual Corporate DirectorBoard Treasurer Nov 20, 2015
Betty E Starr Individual Corporate DirectorBoard Secretary Jul 12, 2015
Pamela Jean J Blake Individual Corporate DirectorBoard Vice Chair Jul 9, 2014
Tri-State Community Healthcare Center Organization, Needles, CA Non-profit Operational/Managerial Control May 1, 2015
Armenak Takhmizyan Individual Corporate DirectorBoard Member Nov 2, 2022
Mary Lou Stein Individual Corporate DirectorBoard Member Mar 14, 2016
Aram Manoukian Individual Corporate OfficerChief Executive Officer,Ceo Jul 1, 2015
W-2 Managing EmployeeChief Executive Officer, Ceo Jul 1, 2011 100%

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Tri-State Community Healthcare CenterAdelanto, CA, CCN 921090 Federally qualified health center Operational/Managerial Control (100%) Mar 1, 2016
Tri-State Community Healthcare CenterLaughlin, NV, CCN 291870 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 18, 2011
Tri-State Community Healthcare CenterLaughlin, NV, CCN 291020 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 18, 2011

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Subparts reporting this organization as parent 12

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 81

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 81

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783641600000",
    "number": "1922356369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 W BROADWAY ST",
            "city": "NEEDLES",
            "state": "CA",
            "postal_code": "923632729",
            "telephone_number": "760-326-0222",
            "fax_number": "760-326-0221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 W BROADWAY ST",
            "city": "NEEDLES",
            "state": "CA",
            "postal_code": "923632729",
            "telephone_number": "760-326-0222",
            "fax_number": "760-326-0221"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1655 N Mount Vernon Ave Unit C",
            "address_purpose": "LOCATION",
            "city": "San Bernardino",
            "state": "CA",
            "postal_code": "924111427",
            "country_code": "US",
            "telephone_number": "909-577-1101",
            "fax_number": "909-577-1102",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "31739 Riverside Dr Ste A1",
            "address_purpose": "LOCATION",
            "city": "Lake Elsinore",
            "state": "CA",
            "postal_code": "925307818",
            "country_code": "US",
            "telephone_number": "951-245-0505",
            "fax_number": "951-245-0999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TRI-STATE COMMUNITY HEALTHCARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-15",
        "last_updated": "2026-07-10",
        "certification_date": "2026-07-10",
        "status": "A",
        "authorized_official_last_name": "MANOUKIAN",
        "authorized_official_first_name": "ARAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-652-6612"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Needles, CA

Sources for this page

Verify at the official NPI Registry.